Cargando…
A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect?
INTRODUCTION: The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance,...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486821/ https://www.ncbi.nlm.nih.gov/pubmed/32931980 http://dx.doi.org/10.1016/j.ijsu.2020.09.011 |
_version_ | 1783581384586035200 |
---|---|
author | McLean, Ross C. Young, John Musbahi, Aya Lee, Jing Xian Hidayat, Hena Abdalla, Nagi Chowdhury, Sabyasachi Baker, Elizabeth A. Etherson, Kevin Jon |
author_facet | McLean, Ross C. Young, John Musbahi, Aya Lee, Jing Xian Hidayat, Hena Abdalla, Nagi Chowdhury, Sabyasachi Baker, Elizabeth A. Etherson, Kevin Jon |
author_sort | McLean, Ross C. |
collection | PubMed |
description | INTRODUCTION: The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and their outcomes. METHODS: Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (February 16, 2020 to March 15, 2020), and after UK government advice (March 16, 2020 to April 15, 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. RESULTS: Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality. CONCLUSION: There appears to be a “lockdown” effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic. |
format | Online Article Text |
id | pubmed-7486821 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74868212020-09-14 A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? McLean, Ross C. Young, John Musbahi, Aya Lee, Jing Xian Hidayat, Hena Abdalla, Nagi Chowdhury, Sabyasachi Baker, Elizabeth A. Etherson, Kevin Jon Int J Surg Prospective Cohort Study INTRODUCTION: The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and their outcomes. METHODS: Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (February 16, 2020 to March 15, 2020), and after UK government advice (March 16, 2020 to April 15, 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. RESULTS: Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p < 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality. CONCLUSION: There appears to be a “lockdown” effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. 2020-11 2020-09-12 /pmc/articles/PMC7486821/ /pubmed/32931980 http://dx.doi.org/10.1016/j.ijsu.2020.09.011 Text en © 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Prospective Cohort Study McLean, Ross C. Young, John Musbahi, Aya Lee, Jing Xian Hidayat, Hena Abdalla, Nagi Chowdhury, Sabyasachi Baker, Elizabeth A. Etherson, Kevin Jon A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? |
title | A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? |
title_full | A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? |
title_fullStr | A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? |
title_full_unstemmed | A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? |
title_short | A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? |
title_sort | single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the covid-19 pandemic: is there a “lockdown” effect? |
topic | Prospective Cohort Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486821/ https://www.ncbi.nlm.nih.gov/pubmed/32931980 http://dx.doi.org/10.1016/j.ijsu.2020.09.011 |
work_keys_str_mv | AT mcleanrossc asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT youngjohn asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT musbahiaya asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT leejingxian asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT hidayathena asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT abdallanagi asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT chowdhurysabyasachi asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT bakerelizabetha asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT ethersonkevinjon asinglecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT mcleanrossc singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT youngjohn singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT musbahiaya singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT leejingxian singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT hidayathena singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT abdallanagi singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT chowdhurysabyasachi singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT bakerelizabetha singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect AT ethersonkevinjon singlecentreobservationalcohortstudytoevaluatevolumeandseverityofemergencygeneralsurgeryadmissionsduringthecovid19pandemicistherealockdowneffect |